Question TRIWEST/Humana Military Referral and pain management help

amowens854

Contributor
Messages
20
Location
Newport, NC
Best answers
0
I was wondering if when a patient has a referral from TRIWEST or from Humana military and they give the accepted Dx or reason for the referral does that mean it has to be the first listed Dx to be paid? I work in Pain management and with Chapter 6 guidelines a patient is being seen for pain management/pain control you are supposed to code G89 then the underlying reason for the pain, if known. What i'm asking is if the "accepted Dx" isn't first and G89 is first then will the insurance pay? Any insight would be greatly appreciated!!
Thanks!!
 

Ashawill765

New
Local Chapter Officer
Messages
1
Best answers
0
And to piggy back off of what Kristina said; TriWest follows the medicare fee schedule/medical policy. But if a code is not listed on the referral from the VA, you should be able to call to request to have it put on.
 
Messages
4
Best answers
0
Hello. From experience with billing to Triwest and denial management with a pain management practice. The primary code should be the code that the patient was referred to the practice for and the authorization is approved for. You mau list the additional assessment codes there after. If the approved dx code is not listed as primary we had where the claims denied. Upon calling Triwest/Tricare and speaking with our VA representative we were advised.
 
Top